RA Messages for August 3, 1999
PHARMACY PROVIDERS, PLEASE NOTE!!!
IF YOU ARE UNSURE ABOUT THE COVERAGE OF A DRUG PRODUCT, PLEASE CONTACT
THE PBM HELP DESK AT 1-800-648-0790
PLEASE MAKE THE FOLLOWING CHANGES TO
THE 8/15/98 VERSION OF APPENDIX A:
| DRUG |
DOSAGE |
STRGTH |
MAC |
EFF.DATE |
| CALCIUM CARBONATE/MG CARB/FA |
TABLET |
200-400-1 |
|
07/01/99 |
| CLARITHROMYCIN |
SUSP RECON |
187.5MG/5ML |
|
06/28/99 |
| FE,CARBONYL/CA CARB/FA/MV-MN |
COMB PKG |
90-1-600MG |
|
07/15/99 |
| HCTZ/SPIRONOLACTONE |
TABLET |
25/25MG |
$0.36030 |
07/26/99 |
| HETASTARCH/E-LYTES,LACTATE |
PLAST.BAG |
6% |
|
06/23/99 |
| ORLISTAT |
CAPS |
120MG (MIN AGE:21) |
|
8/15/99 |
| RESPERIDONE |
TABLET |
0.25;0.5MG |
|
07/12/99 |
PLEASE FILE ADJUSTMENTS FOR CLAIMS
WHICH MAY HAVE BEEN INCORRECTLY PAID
ATTENTION ALL PROVIDERS- RECIPIENTS NEW PERMANENT ID
IF YOU RELY ON ANOTHER ENTITY (I.E., BILLING SERVICE, CLEARINGHOUSE,
ETC.) TO BILL CLAIMS OR RECONCILE ACCOUNTS ON YOUR BEHALF, PLEASE SHARE
THE INFORMATION WITH THEM. IF THESE ENTITIES ARE NOT INFORMED AND/OR ARE
NOT Y2K READY, IT COULD CAUSE ADDITIONAL DIFFICULTY FOR YOU!
BEGINNING JULY 6, 1999, A PERMANENT 13 DIGIT RECIPIENT NUMBER WILL BE
ASSIGNED TO EACH MEDICAID RECIPIENT. ALTHOUGH THE PERMANENT NUMBER WILL
FREQUENTLY LOOK THE SAME AS THE CURRENT MEDICAID RECIPIENT
IDENTIFICATION NUMBER ASSIGNED TO A RECIPIENT, THIS NUMBER WILL NOT DENOTE ANY
INFORMATION RELATED TO PARISH OR ELIGIBILITY TYPE. EACH RECIPIENT ON
FILE AS OF 6/30/99 WILL HAVE THE MOST CURRENT 13 DIGIT NUMBER SELECTED
AS THE PERMANENT NUMBER. THIS DOES NOT MEAN THE OTHER ID NUMBERS ISSUED
TO RECIPIENTS CANNOT BE USED TO BILL. IN FACT, WHEN BILLING FOR SERVICES
WHICH HAVE BEEN PRE-CERTIFIED OR PRIOR AUTHORIZED, IT WILL BE NECESSARY
TO BILL USING THE NUMBER UNDER WHICH THE PRECERTIFICATION OR PRIOR
AUTHORIZATION WAS ISSUED. BEGINNING 7/99, WE ENCOURAGE PROVIDERS TO
MAKE NOTE OF THE IDENTIFICATION NUMBER CONFIRMED OR OBTAINED FROM
UNISYS REVS TELEPHONE INQUIRY OR THE MEVS AUTOMATED INQUIRY SYSTEM AS
THIS WILL BE THE PERMANENT NUMBER.
IT IS IMPORTANT THAT YOU ACCESS REVS OR MEVS TO VERIFY ELIGIBILITY. IF
YOU RELY ON ANOTHER ENTITY(I.E., BILLING SERVICE, CLEARINGHOUSE, ETC.)TO
BILL CLAIMS OR RECONCILE ACCOUNTS ON YOUR BEHALF, PLEASE SHARE THIS
INFORMATION WITH THEM. IF THESE ENTITIES ARE NOT INFORMED AND/OR ARE NOT Y2K
READY, IT COULD CAUSE ADDITIONAL DIFFICULTY FOR YOU.
NOTICE TO HOSPITALS
FIMS# 5744
24 HOUR INPATIENT/OUTPATIENT RULE CLARIFICATION
ALL OUTPATIENT SERVICES PERFORMED WITHIN 24 HOURS OF THE INPATIENT
ADMISSION SHOULD BE INCLUDED IN THE INPATIENT STAY.
SPECIFICALLY, ALL OUTPATIENT SERVICES PERFORMED WITHIN 24 HOURS BEFORE
THE INPATIENT ADMISSION AND 24 HOURS AFTER THE DISCHARGE SHOULD BE
INCLUDED IN THE INPATIENT STAY.
WHEN A PATIENT HAS OUTPATIENT SERVICES PERFORMED AT ONE HOSPITAL WHILE
THEY ARE INPATIENT AT ANOTHER HOSPITAL, ALL CHARGES SHOULD BE INCLUDED
ON THE INPATIENT HOSPITAL'S CLAIM.
THE HOSPITAL IN WHICH THE PATIENT IS AN INPATIENT IS RESPONSIBLE FOR
REIMBURSING THE HOSPITAL PERFORMING ANY OUTPATIENT SERVICES DURING THE
PATIENT'S STAY.